It’s Not Only The Lonely

Do only the lonely die young, or does social connection and support affect most measures of health and longevity? Yes, it’s true: the less social connections you have, the greater the tendency towards illness of many kinds – physical and mental.

Even if you don’t feel lonely at all.

But how big an effect? For how long? Some of the details are starting to get worked out, and the effect size is big – a lot bigger than health researchers and clinicians tend to notice – not to mention the public.

Positive effects for “social integration” – having lots of contacts and friends and acquaintances – and negative effects for “social strain” – having relationships that cause upset and ill-feeling. But the effect shifted in different age cohorts.

What Group Was Different?

Those in the middle of life. In the MIDUS study, looking at folks in their 30-50s, having lots of friends did not affect mortality and depression rates as much as the ill effects of unhappy and unsatisfying relationships. For the young and old, having social connections alone appeared to work very, very well.

Why Did This Happen?

Like many other things, at this stage it’s mostly speculation. Between the 30 and 50s families grow and change as kids are born, grow up and hopefully mature. Strained marriages and difficulties child rearing appear to take quite a toll on overall health.

How Does Social Support Work Biologically?

Presently the $64,000 question, or whatever it’s inflation linked, Powerball related value might be. Many studies now describe changes in inflammatory markers like C reactive protein that correlate well with how many social connections you have. But most of these biomarkers are far less worthwhile than a clinical marker like “fever.” Immunity and neural function are so deeply interlinked on so many levels – most of which are still unexplored or not yet guessed at – that people remain fairly clueless about how it all works. It’s another project for the renaissance of “Big Data.”

How Important is Social Support?

Very. In one meta-analysis done in 2010, looking at 148 studies with about 309,000 participants, the authors figured people with “stronger” social relationships had about 50% better chance of survival than those without. They effect size was about as big as occurs with tobacco, presently the number one scourge of public health. The authors admitted the effects were probably underestimated, as many studies looked at only one measure of social isolation.

How Does Social Media Figure In This?

Is a Facebook or Instagram friend like an ordinary friend?

At this point that’s also unknown – and difficult to study. Despite reams of data, it’s hard separating the “friendness” quotient of social media versus the face to face contact historically associated with social connection. There’s also plenty of linguistic ambiguity – the meaning of “friend” on social media is very different from that of ordinary discourse, and varies a lot from one person to another. Plenty of studies have tried to depict social media as increasing loneliness and social isolation, particularly through its “curated” view of reality, and the different personae one develops for social media versus everyday, face to face life.

What Does All This Mean Clinically?

Simply that social engagement, social isolation, social support and social strain – the sum of one’s relationships with other human beings – has a huge effect on health. It’s a big part of why organizations like AA work – or are perceived to work. It’s a large component of treatment for depression – depressives naturally become more socially isolated which makes their conditions worse. It’s a significant part of what should be clinical treatment for cardiovascular disease, still the biggest killer in the world. The original social support studies of the 1970s showed sizable effects of social support on heart attack and stroke risk, as well as risk of high blood pressure. That’s still true. Cardiologists would probably get better results if they got their patients socially engaged and checked out social strain within families – but first they would have to notice these problems. It probably won’t appear on most insurance company checklists anytime soon.

Why Is Social Support’s Effect So Underappreciated?

Because it’s hard to make a simple public health or clinical intervention regarding social support. Despite Dale Carnegie courses, it’s difficult to make new friends at will – especially when people are ill. Similarly, building community and social “infrastructure” takes time and effort.

Yet lots can be done. Mobilizing social networks can play a big part in mental health – especially at preventing and treating depression, bipolar illness, schizophrenia and addictions. It has a much bigger part to play in combating cardiovascular risk – and even cancer – that most folks imagine.

And one of the best ways to use it is to recognize what social network people have – and then to get them to mobilize and engage them. That’s what humans do. We’re social animals.